Abstract Body (Do not enter title and authors here): Introduction: Pulmonary dysfunction is a risk factor for increased mortality in patients with acute coronary syndromes (ACS). The purpose of this study was to investigate the association between thrombogenicity and pulmonary function test abnormalities in patients with ACS.

Methods: We included ACS patients who underwent successful percutaneous coronary intervention (PCI). Pulmonary function was assessed by spirometry based on the forced expiratory volume in one second (FEV₁%pred) after PCI. Thrombogenicity was evaluated with the thromboelastography and conventional hemostatic measures.

Results: Among 323 patients, 90 patients (28.8%) had pulmonary dysfunction (moderate or severe spirometric abnormality, FEV₁%pred <70). Patients with pulmonary dysfunction had higher levels of conventional biomarkers for thrombogenicity (D-dimer, 1.24±1.9 vs. 0.78±1.08 ug/mL, p=0.016, and fibrinogen, 383±124 vs. 331±90 mg/dL, p<0.001, respectively). On thromboelastography, platelet-fibrin clot strength (PFCS) was significantly higher in patients with pulmonary dysfunction (69.2±5.9 vs. 65.4±6.7 mg/dL, p<0.001). High PFCS (≥ 68 mm) was associated with pulmonary dysfunction (OR, 2.30, 95% CI 1.41 – 3.76, p=0.001). All-cause death rate for 3-years was increased in pulmonary dysfunction and high PFCS (23.3% vs. 14.1%, Log-rank test p=0.003, and 27.9% vs. 10.8%; Log-rank test p=0.003, respectively) (Fig. 1).

Conclusions: This study showed the association between heightened thrombogenicity and pulmonary function test abnormalities and their prognostic implications in ACS patients. This study suggests a pathogenetic mechanism for the poor prognosis of patients with pulmonary dysfunction after PCI.